Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202201211
Jornal Vascular Brasileiro
Original Article

Correlação das medidas ultrassonográficas, tomográficas e intraoperatórias da veia safena interna utilizada como enxerto arterial

Correlations between ultrasound, tomographic, and intraoperative measurements of the great saphenous vein used as an arterial graft

Vinicius Adorno Gonçalves; Daniel Martins Vieira Zimmermann; Fábio Hüsemann Menezes

Downloads: 0
Views: 697

Resumo

Resumo: Contexto: A veia safena interna é a principal veia superficial do membro inferior, sendo também a mais utilizada para cirurgias de enxerto arterial para revascularização de membros inferiores. O conhecimento prévio da qualidade da veia pode orientar a mudança da estratégia terapêutica, evitando cirurgias fadadas ao insucesso. Observou- se, com frequência, a discrepância entre achados intraoperatórios e exames de imagem.

Objetivos: Avaliar e comparar o calibre da veia safena interna através de dois métodos de imagem [ultrassonografia (USG) dúplex e angiotomografia computadorizada (angio TC)] e do padrão-ouro (medida no intraoperatório).

Métodos: Tratou-se de estudo prospectivo observacional. Os dados coletados foram obtidos dos procedimentos médicos de rotina realizados pela equipe de Cirurgia Vascular.

Resultados: Foram avaliados 41 pacientes, seguidos clinicamente por 12 meses, sendo 27 (65,8%) do sexo masculino, com média de idade de 65,37 anos. Dezenove (46,3%) pacientes foram submetidos a enxerto fêmoro-poplíteo, e 22 (53,7%) a enxertos distais. Os diâmetros da veia safena foram em média 16,4% menores na TC e 33,8% menores na USG, quando medidos em decúbito dorsal no pré-operatório, comparados ao diâmetro externo após dilatação hidrostática no intraoperatório. Não houve diferença estatística das medidas da cirurgia quando se comparou sexo, peso e altura.

Conclusões: A avaliação do calibre da veia safena foi subestimada pelos exames de USG e TC pré-operatórias com o paciente em decúbito dorsal, em relação à medida intraoperatória. Em pacientes em programação de enxerto para revascularização, a escolha do conduto deve levar esse dado em consideração para que não ocorra exclusão precipitada do uso da veia safena no planejamento.

Palavras-chave

veia safena, doença arterial periférica, ultrassonografia, tomografia

Abstract

Background

The great saphenous vein is the major superficial vein of the lower limb, and also the most often used as arterial graft material for lower limb revascularization. Prior knowledge of the quality of the vein can guide choice of therapeutic strategy, avoiding surgery that is doomed to failure. Discrepancies between intraoperative findings of the quality of the great saphenous vein and imaging tests are also frequently observed.

Objectives

To evaluate the diameter of the great saphenous vein using two imaging methods (Duplex Ultrasound and Computed Tomography) and the gold-standard (intraoperative direct measurement of the vein), comparing the results.

Methods

Prospective, observational study of data obtained during routine medical procedures performed by the Vascular Surgery team.

Results

41 patients were evaluated, with a 12-month follow-up. 27 (65.85%) were male and mean age was 65.37 years. 19 (46.34%) patients had femoropopliteal grafts and 22 (53.66%) had distal grafts. Preoperative saphenous vein internal diameters measured with the patient supine were on average 16.4% smaller on CT and 33.8% smaller on US than the external diameters measured after intraoperative hydrostatic dilatation. There were no statistical differences in measurements when sex, weight, and height were considered.

Conclusions

Saphenous vein diameters were underestimated by preoperative US and CT scans when compared to intraoperative measurements. Thus, in patients undergoing graft planning for revascularization, the choice of conduit should take this data into consideration, so that use of the saphenous vein is not ruled out unnecessarily during planning.

Keywords

saphenous vein; peripheral arterial disease; ultrasound; tomography

References

1 Johnston WF, West JK, Lapar DJ, et al. Greater saphenous vein evaluation from computed tomography angiography as a potential alternative to conventional ultrasonography. J Vasc Surg. 2012;56(5):1331-7.e1. http://dx.doi.org/10.1016/j.jvs.2012.04.055. PMid:22801108.

2 Caggiati A, Bergan JJ. The saphenous vein: derivation of its name and its relevant anatomy. J Vasc Surg. 2002;35(1):172-5. http://dx.doi.org/10.1016/S0741-5214(02)52480-0. PMid:11802151.

3 Slim H, Tiwari A, Ritter JC, Rashid H. Outcome of infra-inguinal bypass grafts using vein conduit with less than 3 millimeters diameter in critical leg ischemia. J Vasc Surg. 2011;53(2):421-5. http://dx.doi.org/10.1016/j.jvs.2010.09.014. PMid:21146343.

4 Broughton JD, Asopa S, Goodwin AT, Gildersleeve S. Could routine saphenous vein ultrasound mapping reduce leg wound complications in patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg. 2013;16(1):75-8. http://dx.doi.org/10.1093/icvts/ivs334. PMid:23044343.

5 El-Sayed HF. Bypass surgery for lower extremity limb salvage: vein bypass. Methodist DeBakey Cardiovasc J. 2012;8(4):37-42. http://dx.doi.org/10.14797/mdcj-8-4-37. PMid:23342187.

6 Lagergren ER, Kempe K, Craven TE, et al. Gender-specific differences in great saphenous vein conduit. a link to lower extremity bypass outcomes disparities? Ann Vasc Surg. 2017;38:36-41. http://dx.doi.org/10.1016/j.avsg.2016.09.003. PMid:27666796.

7 Manetta F, Yu PJ, Mattia A, Karaptis JC, Hartman AR. Bedside vein mapping for conduit size in coronary artery bypass surgery. Journal of the Society of Laparoendoscopic Surgeons. 2017;21(2):e2016.00083. http://dx.doi.org/10.4293/JSLS.2016.00083. PMid:28439192.

8 Bintu Munda Jah-Kabba AM, Kukuk GM, Hadizadeh DR, et al. Mapping of autogenous saphenous veins as an imaging adjunct to peripheral MR angiography in patients with peripheral arterial occlusive disease and peripheral bypass grafting: prospective comparison with ultrasound and intraoperative findings. PLoS One. 2014;9(11):e112340. http://dx.doi.org/10.1371/journal.pone.0112340. PMid:25405867.

9 Jauhari YA, Hughes CO, Black SA, et al. Endoscopic vein harvesting in lower extremity arterial bypass: a systematic review. Eur J Vasc Endovasc Surg. 2014;47(6):621-39. http://dx.doi.org/10.1016/j.ejvs.2014.02.009. PMid:24642296.

10 Khan SZ, Rivero M, McCraith B, Harris LM, Dryjski ML, Dosluoglu HH. Endoscopic vein harvest does not negatively affect patency of great saphenous vein lower extremity bypass. J Vasc Surg. 2016;63(6):1546-54. http://dx.doi.org/10.1016/j.jvs.2016.01.032. PMid:27005753.

11 Fattoum M, Kennel S, Knez P, Schmitz-Rixen T, Khout H, Tenholt MH. Lower extremity arterial revascularization using conditioned small-diameter great saphenous vein. J Vasc Surg. 2016;64(3):819-23. http://dx.doi.org/10.1016/j.jvs.2016.06.004. PMid:27565601.

12 Van der Velden SK, de Maeseneer MGR, Pichot O, Nijsten T, van den Bos RR. Postural diameter change of the saphenous trunk in chronic venous disease. Eur J Vasc Endovasc Surg. 2016;51(6):831-7. http://dx.doi.org/10.1016/j.ejvs.2016.02.019. PMid:27090741.

13 Freitas DJ, Love TP, Kasirajan K, et al. Computed tomography angiography-based evaluation of great saphenous vein conduit for lower extremity bypass. J Vasc Surg. 2013;57(1):50-5, discussion 55. http://dx.doi.org/10.1016/j.jvs.2012.06.077. PMid:22963811.

14 Jones T, Stea N, Stolz U, Adhikari S. Ultrasound evaluation of saphenous vein for peripheral intravenous cannulation in adults. J Vasc Access. 2015;16(5):418-21. http://dx.doi.org/10.5301/jva.5000383. PMid:25953210.
 


Submitted date:
09/15/2022

Accepted date:
01/20/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
646cf5b5a953953e627e7463 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections